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The Dizzy Patient University of Texas Health Science 眩晕患者德克萨斯大学健康科学
* * * * THE DIZZY PATIENT Otologic evaluation LEARNING OBJECTIVES After reviewing this module, the student will have the ability to: Develop a broad working diagnosis of the dizzy patient Evaluate the dizzy patient by physical exam and know when to refer for advanced testing Gain a basic understanding of inner ear anatomy and physiology Understand when the dizzy patient warrants consultation to Otolaryngology CASE PRESENTATION 52 year old female with hypertension is referred to the ENT clinic for dizziness. Patient reports that she gets dizzy spells several times per week. These spells last seconds, and she describes the episodes as feeling like the room is spinning around her. The dizziness seems to be brought on by changes in position, specifically turning her head to the right or rolling over in bed to her right side. The dizzy spells seem to resolve on their own after several seconds. No associated neurologic symptoms. Patient denies hearing loss, otalgia, otorrhea, aural fullness, tinnitus. Denies noise exposure, ear trauma, prior ear surgery, or family history of hearing loss. What is your differential diagnosis? DIFFERENTIAL DIAGNOSIS There is a very broad differential for Dizziness: “VITAMIN C” mnemonic Vascular Orthostatic hypotension Cardiac arrhythmias, valve stenosis Brainstem cerebrovascular disease Migraine Infectious Labyrinthitis – postviral Meningitis Traumatic Autoimmune Metabolic/Medications: Diabetes Thyroid disease Aging Idiopathic/Iatrogenic Psychiatric/hyperventilation Vasovagal Neoplastic Cerebellopontine Angle Tumors (Vestibular schwannoma) Congential Other: Medications Medication side effects Ototoxicity Otologic (Vestibular) causes Benign Paroxysmal Positional Vertigo (BPPV) Meniere’s disease ETIOLOGIES OF DIZZINESS Dizziness is most common presenting complaint in patients 75 years or older Postural stability/balance involves integration of input from various systems: Visual + Proprioceptive + Somatosensory + Vestibular (Inner
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